An observational treatment study of metacognition in anxious-depression
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Abstract
Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm ( β =0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group ( β =0.31, SE = 0.08, p<0.001), but not among controls ( β =0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.
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- Authors
- Fox, C. A., Lee, C. T., Hanlon, A. K., Seow, T. X., Lynch, K., Harty, S., Richards, D., Palacios, J., O'Keane, V., Stephan, K. E., & Gillan, C. M.
- Affiliations
- Trinity College Dublin (IE)
- Wellcome Centre for Human Neuroimaging (GB)
- SilverCloud (Ireland) (IE)
- Department of Psychiatry, Trinity College Dublin
- University of Zurich (CH)
- Corresponding author
- Fox, Celine Ann
- ORCID
- Venue
- eLife
- Publisher
- eLife Sciences Publications, Ltd
- Published
- 2023-10-11
- Volume
- 12
- ISSN
- 2050-084X (ISSN-L)
- PMC
- PMC10567110
- OpenAlex
- W4384206666
- Cited by
- 34
- References
- 53
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 14 · 2023: 1
- FWCI
- 8.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- eLife (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- MQ: Transforming Mental Health (MQ16IP13)
- Science Foundation Ireland (19/FFP/6418)
- European Research Council (ERC-H2020-HABIT)
- Government of Ireland Postgraduate Scholarship Programme (GOIPG/2020/662)
- Irish Research Council (Enterprise Partnership Scheme IRC/EPSPG/2020/8)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- metacognition, anxious depression, metacognitive bias, transdiagnostic vulnerability, internet-based cognitive behavioral therapy, antidepressants, treatment response, performance confidence
- MeSH terms
- Metacognition, Antidepressive Agents, Anxiety, Cross-Sectional Studies, Depression, Humans, Treatment Outcome, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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